US · guidance
CMS Pub. 100-04, ch. 32, § 11.3.4
Payment Method
Payment for PRP services is as follows:
• Hospital outpatient departments TOBs 12X and 13X – based on the Outpatient Prospective Payment System
• Skilled Nursing Facility TOBs 22X and 23X – based on the Medicare Physician Fee Schedule (MPFS)
• TOB 71X – based on the all-inclusive rate
• TOB 75X – based on the MPFS
• TOB 77X – based on the all-inclusive rate
• TOB 85X – based on reasonable cost
• Critical Access Hospitals TOB 85X and revenue codes 096X, 097X, or 098X – based on the MPFS
Local MACs shall pay for PRP services for hospitals in Maryland under the jurisdiction of the Health Services Cost
Review Commission on an outpatient basis, TOB 13X, in accordance with the terms of the Maryland waiver.
History
(Rev. 11214, Issued: 01-20-22, Effective:04-13-21, Implementation: 01-03-22 Shared Systems Contractors, 02- 14-22 MACs)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
524c4d69b0967a45ed71b71243ab34fe12070747aec4e519cb5553adfac3a398
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